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Dec 14 2012

Medical-Legal Partnerships: When medicine and self-care aren’t enough

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Medical professionals have long understood that patients' wellbeing is influenced by many factors that are outside of the traditional purview of medical and self-care. "We know that psychosocial stress has a significant impact on our patients' health,” notes Meggan Goodpasture, MD, Assistant Professor of Pediatrics at Wake Forest Baptist Medical Center. “Too often our efforts to help our patients are limited because we can't address the underlying problems that they're experiencing outside of the medical office."

A growing network of Medical-Legal Partnerships (MLPs), which team hospitals and clinics, clinicians, patients and families with lawyers, is helping to change that. These partnerships represent a valuable resource that clinicians may call on to help address some of the social and environmental determinants of health. These include substandard housing conditions; domestic violence; food, income and housing insecurity; improper denials of Medicaid and other public benefits; failure to provide children special education services to which they are entitled; and end-of-life issues.

When a clinician becomes aware of social and environmental factors that threaten a patient’s health, he or she makes a referral to a medical-legal partnership. A legal team is assigned to the case and intervenes on the patient’s behalf to resolve problems. For example, an MLP might be contacted to help a cancer patient overcome bureaucratic hurdles with a Food Stamps application (see case studies). Services are made available to patients at no charge.

The Medical-Legal Partnership model has been endorsed by the American Bar Association, the American Medical Association, the American Academy of Pediatrics and numerous other national organizations. During 2010, more than 80 MLPs nationwide partnered in 235 hospitals and health centers to provide legal assistance to more than 34,000 individuals and families. MLPs fostered cooperation among 23 medical schools and 29 law schools as well as legal services organizations and
hundreds of private law firms and other pro bono partners who provided more than $13 million in in-kind services to medicallegal partnerships.

In North Carolina, Medical-Legal Partnerships have been established in seven locations, including Durham, Chapel Hill, Winston-Salem, Greensboro, Charlotte, Asheville and Prospect Hill (see chart pg. 11). Each MLP is designed to address the particular
needs and capacity of the local partners. However, they all share common components, including:
  • Basic legal training for health care providers to help them screen and refer patients who may benefit from legal assistance;

  • Regular presence of legal staff in clinic settings to conduct outreach to staff and to allow for patients to be screened for eligibility for legal assistance;

  • Formal referral mechanisms between medical providers and legal partners; and,

  • Direct legal assistance to patients-clients.

Medical-Legal Partnerships make sense. Health care providers are more likely to screen patients about problems when they know that they can refer patients for services to address those concerns. Lawyers can often get better results for a client when a
medical professional is on the team. And, by collaborating with lawyers, medical professionals are gratified to see that they can often improve the health of their shared patients/clients. Michael Steiner, MD, Chief of the Division of Pediatrics and Adolescent Medicine at UNC Health Care’s North Carolina Children's Hospital said being part of an MLP has been positive for staff and patients.

"We see children for about 20 minutes, three or four times a year, at the most,”Steiner said. “But outside of that time is where their lives are truly happening. Since forming the MLP, our staff feels more empowered to help families with issues that we cannot reach. Through partnerships like MLPs, medical providers can broaden our impact and go much further to improve the health and wellbeing of the patients and families that we care for."

Get in touch with medical-legal partnerships in NC by contacting Madlyn Morreale at (919) 226.5912 or madlynm@legalaidnc.org.

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Medical-Legal Parnership Programs in North Carolina


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